Update on Labs - What is Going On? :-)

[clethe]

Labs done ~7AM - 24 hours after T4 and 12 hours after T3, having stopped biotin 4 days prior.

My endo has been good about letting me have needed T3 after being deficient for over a decade with other doctors. I am not sure what to make of the labs since she upped my T3 back in December. I started dosage change 12-2-2014 (100mg Synthroid, 20mcg Liothyronine).

Labs 3 weeks after dosage change:

12-21-2023 (100mg Synthroid, 20mcg Liothyronine)

TSH not tested

Free T4 1.08 (0.82 - 1.77) 27.4%

Free T3 2.60 (2.0 - 4.4) 25.0%

4AM 100mcg Synthroid

4AM 10mcg Liothyronine

Noon 10mcg Liothyronine

Labs 3 months on continuing dosage:

3-1-2024 (100mg Synthroid, 20mcg Liothyronine)

TSH 0.016 (0.45 - 4.50) -10.7%

Free T4 1.41 (0.82 - 1.77) 62.1%

Free T3 2.7  (2.0 - 4.4) 29.2%

4AM 100mcg Synthroid

4AM 10mcg Liothyronine

Noon 10mcg Liothyronine

Labs 6 months on continuing dosage:

6-13-2024 (100mg Synthroid, 20mcg Liothyronine)

TSH not tested

Free T4 1.47 (0.82 - 1.77) 68.4%

Free T3 3.10 (2.0 - 4.4) 45.8%

4AM 100mcg Synthroid

4AM 5mcg Liothyronine

Noon 10mcg Liothyronine

8PM 5mcg Liothyronine

It is interesting that my levels continue to increase 6 months out from dosage change. I did change the timing of the meds after 3-1 labs. And also increased my Vit D a bit and levels have gone from 58 to 68 (range 30-100). Could those changes affect levels that much or is my body just really slow catching up to increased meds? 🙃

[SlowDragon Administrator]

How do you feel

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

T3 ….day before test split T3 as 2 or 3 smaller doses spread through the day, with last dose approximately 8-12 hours before test

6-13-2024 (100mg Synthroid, 20mcg Liothyronine)

TSH not tested

Free T4 1.47 (0.82 - 1.77) 68.4%

Free T3 3.10 (2.0 - 4.4) 45.8%

4AM 100mcg Synthroid

4AM 5mcg Liothyronine

Noon 10mcg Liothyronine

8PM 5mcg Liothyronine

And test was 8am next morning?

You also need to test vitamin D, folate, ferritin and B12

What vitamin supplements are you taking

[clethe in reply to SlowDragon]

Thank you, yes - have been doing all those things as protocol for labs for years for consistency - labs before 8AM usually by 7AM. Vits are good, D is listed above, B12 is always very high despite small supplement in B Complex, ferritin is always 'normal'.

Just wondering what is causing my lab levels of FT4 & FT3 to slowly increase over the past 6 months with no change in doses 🤨 and wondering how much higher they might go. Is this normal - increasing as the body gets used to it?

Usually, it is recommended to test 6 weeks after a dosage change. Here 6 weeks was not the end result 🙂

[Ukie]

Just in case it’s relevant, Medichecks are currently saying 2 weeks without B12 before bloods.

[clethe in reply to Ukie]

Thank you - have not seen that direction from labs in the US, which reminds me that my Dr had once used Methylmalonic Acid lab test in addition to B12 to verify results since my level is always very high. The test result came back as 93 with range of 0-378. According to Healthline "When vitamin B-12 deficiencies occur, methylmalonic acid levels increase." Will ask her about that this next visit.

Also, in looking at B12 supplements online there are references to it being 'cobalt' which had never occurred to me. Having eliminated all metals from my diet because of eczema, I was shocked to find that I may be continuing to exacerbate the rashes with B12 supplements! Ugh!

It is 'almost' impossible to find a B vitamin complex without B12.

[gabkad]

Your previous tests had the T3 dose 21 hours prior to the test so the fT3 will be lower since half life is short. With the T3 spread out during the day, last dose at 8 p.m., the fT3 will be higher in the a.m.

[clethe in reply to gabkad]

Thank you for clarification, the times listed are for my 'daily doses'. Before labs, I follow protocol listed at the beginning of my post: "Labs done ~7AM - 24 hours after T4 and 12 hours after T3, having stopped biotin 4 days prior." So, I would always take 5mcg of my 20mcg liothyronine ~8PM the night before labs. After the 3-1 labs I changed the timing of my 'daily doses' to 4AM, Noon and 8PM on a regular basis.

So, that was one of my questions - whether changing timing of my 'daily doses' after 3-1 had affected my lab results, increasing FT3.

[gabkad in reply to clethe]

The circadian rhythm of thyroid hormone secretion in healthy young people rises about 10 p.m. It increases during the night and then starts to descend during the day. The variation, based on the 3.8 to 6.8 range is 5.2 to 5.6.

From a natural point of view, it would make more sense to take 10 mcg at bedtime, 5 mcg in the morning and 5 mcg at noon. That way you would be more closely mimicking how the body usually behaves. You could also more easily test 12 hours after the last dose without modifying the regimen.

[clethe in reply to gabkad]

May be worth a try - have been battling extreme crashing ~10AM-12 noon but taking 10mcg at 4AM seemed to make it worse. Moved 10mcg to noon and do better in the afternoon and early evening. Spacing doses out every 8 hours allows for some 4-hour windows to take magnesium & calcium away from meds, otherwise I might consider taking 5mcg every 6 hours.

[gabkad in reply to clethe]

'Crashing' can also be related to blood glucose fluctuations.

[clethe in reply to gabkad]

Yes - must eat something on a schedule or get hypoglycemic - but still crash mid morning. Also have multiple food and environmental allergies so it gets complicated. Have been dairy-free, low/no sugar low carbs for years. Tried gluten-free for 2 years - it made no difference, but still limit gluten, very little bread, no baked goodies. Diet of mostly veg (those not allergic to), some nuts/nut butter, limited fruit, one egg per day and small amount lean chicken or turkey 2-3 times per week. Spring water. Used to be able to eat anything, now even handling certain vegetables causes eczema outbreak. All of this mess started up about the same time as diagnosis of Hashi in 2012.

Wore a glucose monitor for 2 years which documented the 'non-diabetic hypoglycemia'.

[gabkad in reply to clethe]

Protein requirement is minimum 0.8 grams per kilogram body weight per day.

From Eating Well website:

Another way to calculate how much protein you need each day is to multiply 0.8 grams of protein per kilogram of your body weight. With a little math, this translates to 54 g of protein for a 150-pound female or 65 g for a 180-pound male. Here are some examples of about 10 g of protein: 2 small eggs.

[clethe in reply to gabkad]

Some years back my calculations were that days without meat had sufficient protein, and days with meat had extra. Using your calculation, it appears that my 'menu' is still providing adequate protein, even eliminating red meat altogether. Last year iron/ferritin labs were 'normal'. Thank you for reminding me to check on these again 🙂